Cerebral hemodynamic changes during intensive care of preterm infants.
OBJECTIVE
The objectives of this study were to examine the circulatory changes experienced by the immature systemic and cerebral circulations during routine events in the critical care of preterm infants and to identify clinical factors that are associated with greater hemodynamic-oxygenation changes during these events.


METHODS
We studied 82 infants who weighed <1500 g at birth and required intensive care management and continuous blood pressure monitoring from an umbilical arterial catheter. Continuous recording of cerebral and systemic hemodynamic and oxygenation changes was performed. We studied 6 distinct types of caregiving events during 10-minute epochs: (1) quiet baseline periods; (2) minor manipulation; (3) diaper changes; (4) endotracheal tube suctioning; (5) endotracheal tube repositioning; and (6) complex events. Each event was matched with a preceding baseline. We examined the effect of specific clinical factors and cranial ultrasound abnormalities on the systemic and cerebral hemodynamic oxygenation changes that were associated with the various event types.


RESULTS
There were highly significant differences in hemodynamics and oxygenation between events overall and baseline epochs. The magnitude of these circulatory changes was greatest during endotracheal tube repositioning and complex caregiving events. Lower gestational age, higher illness severity, chorioamnionitis, low Apgar scores, and need for pressor-inotropes all were associated with circulatory changes of significantly lower magnitude. Cerebral hemodynamic changes were associated with early parenchymal ultrasound abnormalities.


CONCLUSIONS
Routine caregiving procedures in critically ill preterm infants are associated with major circulatory fluctuations that are clinically underappreciated and underdetected by current bedside monitoring. Our data underscore the importance of continuous cerebral hemodynamic monitoring in critically ill preterm infants.
Limperopoulos
Catherine
C
Department of Neurology and Neurosurgery and School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
Gauvreau
Kimberlee K
KK
O'Leary
Heather
H
Moore
Marianne
M
Bassan
Haim
H
Eichenwald
Eric C
EC
Soul
Janet S
JS
Ringer
Steven A
SA
Di Salvo
Donald N
DN
du Plessis
Adré J
AJ
D001810:Blood Volume; D001921:Brain / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003422:Critical Care; D006305:Health Status Indicators; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D019102:Infant, Very Low Birth Weight; D007442:Intubation, Intratracheal; D015999:Multivariate Analysis; D010108:Oxyhemoglobins / Q000032:analysis; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared
D010108:Oxyhemoglobins